HomeMy WebLinkAboutPermit Backflow Test 2004-3-19
.',<'." "','.'...<.....r'...".O....f,"sr IN'.....plE'ttl 'OLitE'\ '.r.. ....' " . .
" ~ t':!1 't>.. '" . nIT.. G GON .
.-1~.-:-.',:~-d;.J.........~I.'\!:;J ,....Ir. ." . "',
\:...l.I,.l.:-.".:.!..~,,<>...~.J._~.'....l..,,_......:..:~_......~:'._l..... ..~... ." ....... .l.... ..' ~ ":~'r
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: ('!IlIt~~oject 85 submitted hes 'he following
ELECTRICAL PERMIT APPliCATION ~~~ir~~e~nd does not require specific land use
City Job Number cO~'Z.O"O"f-OOZ7S-- Datc O>lgo~, Zoning C-.(!....
- ~-lc;-Ott-
3, &~r!~1~;~E;~~J!s~rdt.v+~V~~..,
'])4~.4afL
STcilP/\/ Y6H
:-',,\ ego" ,. ,-,/- ,:;>..- E. [~K1i~~~ir.iIlfi,~'s~1Wf~~~w.;iji'ihi~}l'i~J~i~r~Yf~'iI;iIf6H~A
r- u . r ATTE~N~regon law~~~ag1"~,~~\llJ:l"'" "'=''''= .~ '. ,. . .." ,
~v, Gr- Phone ,,_... ., oIM "rlnnted by tRumpror;iiiigJti8liIY $ 50.00,
~~~iii~ation Center. ThoSESigivOutlirlerlliMti~ $ 50,00
OWNER INSTALLA nON n OAR 952.001.001 0 thrOI!.iiliit'cit1;1e~W/R~~dential $ 25,00
""'" ~ ,,'r cbtain corri:>"J'dftEhe ru/'c"'s I . I $ 45 00
The installa'ion is being made on1\lro~ lOtJri1wliicli "'mIte nerllY. ommerc.. ,
, , Ill... ';w" . il er (I\IQ~P,: !):Ie.tel~pllg~e
IS not Intended for sale. lease or ri'l'i . j~Jm'~I'mJ,\r, E!i~~~! Inspection Fee Is $45.00 + Surcharges
AlftI.'i Z .~,:m~ . , ., ~i.lf:i~:>itlR~ltl;~.;oo-~1
Owners Signalure: COMMENCED OR IS' ABMtl,'i . ~~~~~,m~.&WllW 9.:s
ANY 180 DAY PERIOD. 7% Slate Surcharge 6~'
10% Administrative Fee 9 yo
TOTAL log 2J
'1. ll!'.t;bCATi6N'ORiNsi;l.,.t14:tioiVC;(;...f' 'il!~
.....,.._~,....,_..,..,I. .......,~.. >'~..,.,.".'.,,-,~.. .''''_' ~:;1.l;,..,.U:aM~.
&101..( mA-'N ,5..
LEGAL DESCRIPTION
/703 JbLf 2-
JOB DESCRIPTION
,/cNM,- :WVPii...L
oz..700
Permits are non.transferable and expire If work is
not started within 180 days of Issuance or if work is
Suspended for 180 days,
~tC(r':'JaGroR'1NSfAi!i1fTiON.:ONL1f.;i
2. r~~~~tw~'~~'l-~J-~~:~'1!.lBtff(\:.i.I'W-l_~1J
Electrical Contractor . C ~ S Y,'lfCA rlC I :TII\C .
Address r. D. BDi \L'~)_
City .5f{\ ,:fe/d. Phone J Lj 1-2 23l.
Supervisor License Number L{-~ q L\ S
1/)-ol-oL/-
3RYQ
9' - / -0 l{
Expimtion Date
Constr, Contr, Number
Expimtion Date
Signalure of Supervising Elecirician
Owners Name
Address
City
Inspection Request: 726-3769
A. It.N~~I,(.R~siarn'tiiiiflrSrn'fi~ijEM,lllti1~1.1i1iirr:'t:'f~U~~inR~~ii1iffi
~~,:,~_'..i.ft1.hC'~~J.~..~,....J\...._..~)'.,P",.f.'_N"'';;iI' g. "
Service Included
1000 sq, ft, or less
Each addi'ional 500 sq, ft, or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106,00
$ 19,00
$50.00
200 Amps or less
201 Ampa to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 Amps/Volts
Reconnect Only
/ $ 63,00
$ 75.00
$125.00
$163,00
$375.00
$ 50,00
c. JiTem'\-"'ora~'1s-el&lc.'ei1Or__Freaefi~~_
1li'1U4h~". rY.; .,,~~,:.~t"'"."""'"'' .
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D. 'Iriir8rtc1ij~i;li~J~~f- 'Ii! )~""1' "" "'" .,
It';';i;~'.il&:.W ~':.lll;1jl'f'ltr~.1.1{lW",. .
$ 50.00
$ 69,00
$100,00
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permi'
$ 43.00
/ 0 $ 3,00
3'D
. ,
Shared Drivc(T:)lBuilding FormslElectricaJ Permit AppUcatioD 1~3.doc
225 Fifth Street ""
Springfield, Oregon 97477
541-726-3759 Phone
JoblJouroal Number
COM2004-00295
COM2004-00295
COM2004-00295
C0M2004-00295
Payments:
Type of Payment
CreditCard
.
.
.,
.oJ
~..,
.........
~-=.o~
lII'f-.~-. "'- -"'.O'..i.
..-... ,
- .
. .
---- . -~....
Receipt #: 2200400000000000261
Description
Perm ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Received By
Ikw
Check Number
Batch Number Authorization Number
Paid By
C & SELECTRIC
000005 018891
'City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 03/1812004 IO:17:38AM
Amount Paid
63.00
30,00
6,51
9.30
S108.81
Item Total:
How Received
Amount Paid
In Person
Payment Total:
S108.81
$108.81
r
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00295
ISSUED: 03/18/2004
APPLIED: 03/18/2004
EXPIRES: 09/18/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2104 MAIN ST
ASSESSOR'S PARCEL NO.: 1703364202700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
New
Commercial
PROJECT DESCRIPTION: Tenant infill- bldg on COM2004-00269
Owner: PARAMOUNT CENTER LLC
Address: PO BOX 26125 EUGENE OR 97402
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
C & SELECTRIC
License
3849
BUILDING INFORMATION I
Expiration Date
09/0112004
Phone
541-741-2236
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Typc
Secondary Construction Type:
# of Bedrooms:
VN
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
SETBACKS
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side I Setback:
SIde 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
AT"r..... ._
NOTICE: I PUBLIC IMPROVEMENTSII)W-;~;~~/\I:OragOn law r
TL!l<' ~ ~"/lcat' adonterl b eqUlres y
Street Improvemen'i\i:RMIT SHALL EXPIRE IF THE WORK I OA '(Side~~II~lyp.e: Y the Ore Ou to
AUHJ(JJ;!17ED UNDER R 95?_nn, ~ r, , hO.~e r gon Util't
Storm Sewer Avlllh\bl~:- THIS PERMIT IS NOT 0090 "'0 Downspoiits/Drains: Ules ara s t I y
(''''''1ENCED 0 ' /I Urn - - "/lOt h e t
Special Instruction: R IS ABANDONED FOR calJin ay Obtain 19 OAR 952 on
ANY 180 DAY PERIOD. nurnbeg the center. (NcoPles of the r -00
Notes: r for the Or ota: the tal ules I
~.. _ _ . _ , :?.~n UWitv ^,,,;phona
-., "-'-2::144), '-"'''un
I Valuation Descrintion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Caleulatcd
Total Value of Project
Paee I of2
.
e CITY OF SrtUl'1~d'l1!,LD
Building/Combination Permit
PERMIT NO: COM2004-00295
ISSUED: 03/18/2004
APPLIED: 03/18/2004
EXPIRES: 09/18/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Une
I F~~s Paid J
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
S9.30
S6.51
S30.00
S63.00
3/18/04
3/18/04
3/18/04
3/18/04
Receipt Number
2200400000000000261
2200400000000000261
2200400000000000261
2200400000000000261
Total Amount Paid
S108.81
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
I R~{)uir~d rmne~tinns I .
I Rough Electric: Prior to Cover
2 Electric Service: Approval required prior to utility company energizing service.
3 Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefully examined the completed application and do bereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done In accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described berein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from tbe
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature
Date
Paee 2 of2